Post-covid in patients with obesity: a narrative review

Implementation science and breast cancer control: A Breast Health Global Initiative (BHGI) perspective from the 2010 Global Summit

Please mind the gap—about equity and access to care in oncology

We hypothesized that the economic status of a region might influence quality of care and outcome of patients with severe brain trauma. Between January 2001 and December 2005, 13 centres enrolled patients with severe brain trauma. Data on accident, treatment and outcomes were collected prospectively. The regions were classified as 'high income' (Austria, five centres), 'upper middle income' (UMI) (Croatia, Slovakia, six centres) or 'lower middle income' (LMI) (Bosnia, Macedonia, two centres). Data on epidemiology, treatment and outcomes were compared according to this classification. Quality of care was assessed using a new scoring system. A total of 1172 data sets were analysed. Patients from the wealthier regions were significantly older. Low-level falls and traffic accidents contributed to more than two-third of all cases. Violence-related trauma was significantly more frequent in 'middle income' regions. Treatment quality was significantly different; treatment according to guidelines for brain trauma management was provided most frequently for patients from high-income regions. Compared with expected mortality rates, mortality was 6.5% lower in the 'high-income' centres, 2.4% lower in the 'UMI' centres and 13% higher in the 'LMI' centres. Advanced age, poor neurological status, high trauma severity and poor quality of care were associated with significantly lower odds for survival. The association between the economic status and outcome of brain trauma patients was due to the quality of care. Successful implementation of guidelines for brain trauma management requires a well-funded health care system.

Pre-Existing Diseases Linked to SARS-CoV-2 Morality: A Comparative Study of Global Burden of Disease in Low- Middle and High Income Countries

Testing the Environmental Kuznets Curve hypothesis: A comparative empirical study for low, lower middle, upper middle and high income countries

Review Questions/Objectives The objective of this review is to synthesise the best available evidence on the effectiveness of population based (public health) risk reduction programs and services (interventions) on sexual and reproductive health risk taking among young people (aged 10 to 24 years old) in developing countries (countries with low and middle gross national income (GNI) per capita as defined by World Bank). The specific review questions are: 1. What is the effectiveness of population based (public health) risk reduction programs and services (interventions) on risky sexual behaviors among young people? 2. What are the characteristics of population based interventions that are effective in reducing risky behaviors among young people? 3. What specific outcome measures best assess the impact of interventions that effectively reduce sexual risk taking among adolescents in developing countries? Inclusion Criteria a. Types of Participants The review will consider individuals of ages 10 to 24 years residing in developing countries. b. Types of interventions The review will consider population based (public health) risk reduction programs and services that target young people in developing countries. c. Types of Outcomes Anticipated outcomes related to reduction in risky sexual behavior among young people include the following: Primary outcomes: Abstinence rates, rates of early/premarital sexual initiation, numbers of sexual partners, condom use at first sex, consistent and correct contraceptive (condom) use during sexual encounters among the study population, alcohol and/or substance use prior to or during sexual encounters (short term outcomes). Secondary outcomes: Pregnancies and their outcomes including rates of abortion, births (live and still), etc., STI rates, HIV/AIDS rates, maternal mortality and educational attainment levels of adolescents in the study population (Long term outcomes).

Causal nexus between energy consumption and economic growth for high, middle and low income countries using frequency domain analysis

Purpose This paper aims to study the specifics of managing the risks of innovative activities during the implementation of the Sustainable Development Goals (SDGs) in entrepreneurship that is focused on the consumer market in countries with different levels of income. Design/methodology/approach The research is performed with the help of regression analysis (one-factor and multiple simple linear regression). Two samples are created for this: (1) countries with high income and (2) upper middle income and countries with lower middle income, according to the classification of World Bank GNI per capita in current USD (Atlas method). Findings It is determined that priorities of the consumer market (demand) are differentiated among countries with different levels of income. In countries with high income and upper middle income, corporate social responsibility does not determine the quality of life. Only competitiveness is a milestone during the implementation of the SDGs in entrepreneurship activities focused on the consumer market. In countries with lower middle income, neither corporate responsibility nor competitiveness is the decisive factor in managing the risks of innovative activities focused on the consumer market. Originality The originality of this research consists in a new view of competitiveness and corporate responsibility from the positions of their influence on the implementation of the SDGs entrepreneurship focused on the consumer market. Social implications Due to the practical implementation of the offered recommendations for corporate management of improving the practice of managing the risks of innovative activities focused on the consumer market, the Quality of Life Index will grow by 44.95% in countries with high income and upper middle income and by 98.69% in countries with lower middle income.

25 Background: Prostate Cancer, the third most commonly diagnosed cancer in 2020 and the fifth leading cause of cancer mortality worldwide, has exhibited significant disparities in global prevalence and impact over recent decades. This study assesses the trends in incidence, mortality, and disability-adjusted life years from prostate cancer in the World Bank regions based on country income levels from 1990 to 2019. Methods: The Global Burden of Disease Study database was used to extract Age-standardized incidence rates (ASIR), age-standardized (ASDR), and life years (DALYs) for prostate cancer from different World Bank regions based on income levels from 1990 to 2019. Annual percentage change was also acquired. Mortality-to-incidence ratios (MIR) were then computed. Trends were assessed using Joinpoint regression. Results: Between 1990 and 2019, ASIRs increased across all income levels, with the greatest growth in the upper middle income (+64.7%). While ASDRs decreased in high income, upper middle income, and lower middle income levels, they notably increased in low income levels (+14.3%). DALYs decreased in high income and upper middle income levels, primarily in the high income (-25.7%), and increased in lower middle and low income levels, primarily in the low income (+13.8%). MIRs decreased in all countries, with the largest decrease in high income levels (-50%). In the last 30 years, high income countries have consistently observed the highest ASIR (2019: 77.5/100,000). However, in 1990 high income countries also had the highest ASDRs and DALYs. Interestingly, by 2019 this pattern shifted, with low income surpassing high income countries in both. Conclusions: Over the last 30 years, the incidence of prostate cancer has been rising regardless of income level. Despite the universal decrease of MIRs implying improved outcomes, screening, and therapeutical strategies, the contrasting trends in ASDRs and DALYs across income levels underscore the disparities in health outcomes. Higher income countries experienced highest cancer incidence but also the highest decrease in the mortality rates while lower income countries faced the opposite challenges with lower increase but higher mortality rates. [Table: see text]

Introduction Telemedicine, once of limited scope, has become common and widespread due to the present and ongoing SARS-CoV-2 pandemic. Center to home delivery, the most common model, allows for convenient and efficient care. Concurrent with this groundshift, there is increasing attention to disparities in medical services, and how these disparities may impact patient outcomes. Telemedicine could be used to help bridge barriers to timely quality care, however, patient access and longstanding institutional biases may limit the potential. Healthcare providers must actively develop systems to ensure that telemedicine is optimized for people across the income spectrum. This exploratory analysis examined how economic disparities in patients being evaluated for obstructive sleep apnea may be associated with providers’ clinical impressions. The objective was to study the inter-method reliability of pre-test probability of obstructive sleep apnea assessed via telemedicine and in-person evaluations, and to compare that reliability between income classes. Methods This is a secondary analysis of a pre-pandemic interrater reliability study, conducted between March 2017 and January 2019. Our researchers completed a randomized, blinded study comparing the pre-test probability of obstructive sleep apnea between an in-person physician and a separate physician seeing the same patient via televideo conferencing. Patients referred to the University of Rochester (UR) Sleep Center were eligible for the study. Women and men 30-70 years old were invited to participate. The patients were not necessarily referred to the center for evaluation of sleep disordered breathing. Patients with dementia, hearing or visual loss, severe psychiatric or developmental illness, or not fluent in English were excluded. Patients had adequate computer literacy, access to high speed internet, and a computing device with appropriate video camera and microphone.The primary objective of the original study was to assess the interrater reliability between the in-person and telemedicine raters for pre-test probability of sleep apnea (high, moderate, or low). Providers used clinical judgement from the history and examination to determine pre-test probabilityFor this present analysis, we assessed the inter-method reliability separately for strata defined by reported annual income level: low income (< $50,000), middle income ($50,000-$100,000), and high income (> $100,000). Reliability was quantified for each stratum using weighted kappa statistics given the ordinal nature of the outcome variable, pre-test probability of obstructive sleep apnea (high, moderate, or low). Weighted kappa statistics were compared between the income strata (high vs. middle, high vs. low, middle vs. low). The operant statistic assumed an approximate standard normal distribution under the null hypothesis of equal kappa values in the two income strata. The Bonferroni method was used to adjust the p-values for the three pairwise comparisons performed among the three income strata. Results Data from 53 patients were avaiable for this analysis. 11 of these patients were in the low income group, 22 in the middle income, and 16 were in the high income group. 9 patients did not include their income bracket, and were not included in the analysis. Inter-method reliabilities, assessed using weighted kappa, were 0.83 (low income), 0.24 (middle income), and 0.66 (high income). When comparing between the strata, the kappa statistics were significantly different (p=0.005) between the low and moderate income groups. There was a trend between the high and moderate income groups that did not meet statistical significance (p=0.07). Conclusion The intermethod reliability was substantial in the low income stratum, moderate in the high income stratum, and slight in the middle income group based on the kappa statistic. There was a significant difference in the reliability values of telemedicine versus in-person assessments between the low and middle income brackets, and there was a trend between the high and moderate groups. Since the raters were unaware of the patients’ income levels, this association might suggest possible unconscious bias in evaluating for OSA. It may also suggest that beyond access to telemedicine technology, the quality of the care may also be influenced by socioeconomic factors. With telemedicine in its early stages, it is important to develop this technology that will minimize biases that could result from patients’ economic fortunes. Support (If Any) The study was funded by a grant from the American Academy of Sleep Foundation (AASM Foundation grant #163-FP-17).

Prior researchers have explored the role of FDI and economic growth or financial development and economic growth in a particular sample of countries or region while no collective studies on the effect of FDI, banks and stock market on economic growth in region or income-based groups have been conducted yet. Using a balanced panel data set of the globe of 193 upper middle income (UMI), lower middle income (LMI) and high income (HMI) countries for the period of 1998 to 2018, the study ever the first time explore the role of FDI, banks and stock markets financial development on economic growth by employing static methods and Dynamic approaches which contributes to the scarce literature on the collective and across income-based groups of countries. All model findings for the global panel indicates that FDI affect economic growth significantly and positively in the global panel, lower middle income (LMI) and upper middle income (UMI) countries where it’s not true for high income (HI) countries. Banking sector development also affect economic growth significantly but negatively in the global panel, high income and upper middle-income countries while not significant for the lower middle income (LMI) countries. Stock market development also affects economic growth significantly but negatively in the global panel. Furthermore, the result concludes that FDI have a larger effect on economic growth than does banks or stock market financial development. This study suggest high income countries regards improving FDI attraction, lower middle income (LMI) countries in regards improve banking sector and collectively suggest to improve major driver and functioning of banking sector and stock markets to spur economic growth. This study is beneficial for the government channels and financial sector of the study countries to make further decision.

The hierarchical Bayesian Dirichlet-multinomial model is explored in this study to estimate small area proportions of socio-economic levels in regional and provincial levels using the Family and Income Expenditure Survey (FIES). The data include 38,484 households which are divided into three socio-economic classes such as low income, middle income and high income based on per capita income (PCI). Dirichlet-multinomial model was used to generate Bayesian small area estimates of households belonging to the low income, middle income, and high income socio-economic levels. Bayesian statistics were generated using Gibb’s sampling and simulation techniques to provide estimates with small Markov Chain Monte Carlo (MCMC) standard errors. Results include direct and Bayesian estimates of households belonging to the three socio-economic groups in regional and provincial levels. Wide disparities in the distributions of low income, middle income, and high income are noted in the results. A notable advantage of Dirichlet-multinomial estimates is the absence of zero proportion in high income level in comparison with direct estimates. Regions and provinces were ranked based on the estimates obtained from the hierarchical Bayesian Dirichlet-multinomial model with comparison on rankings using the direct estimates.

Association of Income Level With Kidney Disease Severity and Progression Among Children and Adolescents With CKD: A Report From the Chronic Kidney Disease in Children (CKiD) Study

BackgroundSepsis causes death and morbidity in young infants. Globally, an estimated 1.3 – 3.9 million young infants experience sepsis and 400,000 – 700,000 die from sepsis-related conditions annually. Even though...

Background: We developed an international physician survey to identify variations in early breast cancer practice, use of guidelines, and key challenges facing clinicians (MDs) globally in implementing guideline-based care. Methods: The survey was administered at an international breast oncology meeting, and also online using a secure platform. Results were analyzed using descriptive statistics and the chi-squared test was used for bivariate analysis. Results: 691 respondents from 70 countries completed the survey. 38% of respondents were from low income (LIC) or middle income (MIC) countries. More respondents in LICs (89%) and MICs (74%) practice in academic centres; 34% of MDs in high income countries (HICs) practice in community settings (P<0.001). More LIC physicians (74%) rely on clinical breast exam for diagnosis versus in MICs (58%) and HICs (55%) (P<0.001). 87% of LIC physicians say that hormone receptor status is routinely reported on pathology, versus in MICs (91%) and HICs (95%) (p=0.011). The reporting of HER2 status also varies by income setting: 83% in LICs, 89% in MICs, and 95% in HICs (P<0.001). Reporting seems to be the lowest in African nations (78% for hormone and 74% for HER2 status, p <0.001 for each). 46% of LIC and 61% of MIC physicians offer sentinel lymph node dissection, versus 94% in HICs (P<0.001). Adjuvant radiation is available in 93% of all surveyed practices. 99% of respondents give eligible patients endocrine treatment; tamoxifen is prescribed almost universally (>96% of respondents). Aromatase inhibitors are given by 87% of LIC, 93% of MIC, and 94% of HIC physicians (p=0.042). 75% of MDs in LICs give chemotherapy to high risk patients; 81% of those in MICs and HICs do the same (NS). More LIC oncologists give classical CMF (21%, p=0.006), and 77% give anthracycline-taxane combinations, compared to 84% of MIC and 88% of HIC physicians (p=0.017). Trastuzumab is given to a majority (>75%) of eligible patients by only 11% of LIC and 36% of MIC physicians, compared to 80% of HIC clinicians (P<0.001). Trastuzumab use is most prominent in North America (85%) and Europe (75%), and lowest in Africa (19%) and Asia (32%) (P<0.001). 94% of LIC and 63% of MIC physicians said trastuzumab use is limited by drug cost (P<0.001); lack of HER2 testing was cited as an issue by only 8-9% of all respondents. 63% of LIC and 76% of MIC physicians say international guidelines impact their clinical practice, compared to 56% of HIC physicians (P<0.001), who are more likely to rely on local/regional guidelines (33%, P<0.001). Conclusions: Global practice patterns in early breast cancer care vary by resource setting but also by continent. More costly therapies such as trastuzumab are used less often in LICs and MICs. Surveyed physicians from LICs and MICs also rely on international guidelines to direct their practice more than HIC physicians. This may reflect that many guidelines with international influence are created in HICs. In order to improve breast cancer outcomes worldwide, global collaboration is required to create guidelines which not only recommend best practice, but are applicable in various resource and cultural settings, and are followed by implementation research efforts. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P1-10-05.